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�zditi <br /> BUILDING PERMIT APPLICATION <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> 1810 E. HAZELTON AVENUE, STOCKTON CA 95205 <br /> BUSINESS PHONE: (209)468-3121 <br /> INSPECTION REQUEST-24 HOUR RECORDER: (209)468-3165 <br /> THE APPLICATION MU T BE COMPLETELY FILLED OUT BY THE APPLICANT IN ORDER TO APPLY FOR <br /> BUILDING PERMITS. <br /> Scope of Work: Mobile He Installation(Temporary) 2nd single famil dwellin ) <br /> Project Addre 13`l §7 -castle Rd. Manteca,CA 95336 _ <br /> Project Valuation: Contact E-mail hhumblehary@hotmail.com <br /> OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS <br /> Name: Lorena Faria Name: Shawn Harvey <br /> Address: 13940 Castle Rd. Address: 419 W. 1St.St. <br /> City: Manteca State: CA City: Ripon State: CA <br /> ZIP: 95336 Ph#(209) 456-7620 ZIP: 95366 Ph#(209)401-1282 <br /> CONTRACTOR INFORMATION Ph#(209)823-9490 <br /> Lic. No: C47-689850 Company Name: Chris' Mobile Home Service <br /> Address: 2303 W. Atherton Drive City: Manteca St:CA ZIP: 95337 <br /> DESIGNER INFORMATION 77t Ph#( ) <br /> Lic. No: Company Name: <br /> Address: City: St: ZIP: <br /> LENDING AGENCY Ph#( ) <br /> Company Name: <br /> Address: City: St: ZIP: <br /> Permit will be issued to an"Owner-Builder" Yes❑ No❑ OFFICIAL USE ONLY <br /> If yes, a completed Owner-Builder Verification Form must Identification Number: <br /> be signed and submitted along with copy of the owner's <br /> identification prior to issuance of the building permit. <br /> DECLARATION BY CONSTRUCTION PERMIT APPLICANT <br /> By my signature below, I certify to one of the following: <br /> I am ❑a California licensed contractor or©the property owner or® authorized to act on the property owner's <br /> behalf(requires written approval and Owner/Builder Verification Form signed and submitted). <br /> I have read this construction permit application and the information I have provided is correct. <br /> I agree to comply with all applicable county ordinances and state laws relating to building construction. I authrwize <br /> representatives of this city or county to enter the above-identified property for inspection purposes_ /. " <br /> Applicant's Signature �s�s�� c Date DV 2n <br /> For your convenience checklists detailing any a itional submittal requirements for various building permit types <br /> are available at the Building Division counter, Demolition permit and mobile home on foundation require check- <br /> list, <br /> FMPPllcatlon Forms&HandoutslHANDOUTS\Building Permit Appllcation.docPage 1 or 2 <br /> ti.-(Revised(07.06-10) <br />